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Booker SQ, Baker TA, Esiaka D, Minahan JA, Engel IJ, Banerjee K, Poitevien M. A historical review of pain disparities research: Advancing toward health equity and empowerment. Nurs Outlook 2023; 71:101965. [PMID: 37023670 DOI: 10.1016/j.outlook.2023.101965] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND PURPOSE This theory-guided review draws on 30 years of published data to examine and interrogate the current and future state of pain disparities research. METHODS Using the Hierarchy of Health Disparity Research framework, we synthesize and present an overview of "three generations" of pain disparities scholarship, while proposing directions for adopting a "fourth generation" that redefines, explains, and theorizes future pain disparities research in a diverse society. DISCUSSION Prior research has focused on describing the scope of disparities, and throughout the historical context of human existence, racialized groups have been subjected to inadequate pain care. It is imperative that research not only illuminates existing problems but also provides solutions that can be implemented and sustained across varying social milieus. CONCLUSION We must invest in new theoretical models that expand on current perspectives and ideals that position all individuals at the forefront of justice and equity in their health.
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Baker TA, Vásquez E, Minahan JA. Variability of Pain Outcomes and Physical Activity Among a Diverse Sample of Older Men: Is It More Than Just Race? Gerontol Geriatr Med 2019; 5:2333721419878587. [PMID: 31633001 PMCID: PMC6767716 DOI: 10.1177/2333721419878587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/24/2022] Open
Abstract
There is a compendium of data documenting the increasing number of older adults.
This suggests the continued need to understand identified health outcomes across
domains of pain and physical activity, particularly among older men. Therefore,
the aim of this study was to evaluate race similarities and/or differences in
pain and rates of physical activity among White, Black, and Hispanic men 60+
years of age. Data were taken from the Health and Retirement Study, a
longitudinal panel study surveying a representative sample of people in the
United States. Logistic regression analysis was used to examine associations
between race and pain and the odds of regular physical activity. Results showed
that Black men were less likely to participate in light or moderate/vigorous
physical activity. Similarly, pain increased the odds of physical activity among
Hispanics, but decreased the odds of physical activity among White men. Findings
may reflect a number of factors that impact the well-being of what it means to
experience pain and physical functioning, while also assuming a masculine
identity. This perspective may allow for a better understanding of short- and
long-term implications of the pain experience and the pain and physical
functioning dyad among this group of men.
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Mixon AS, Kripalani S, Stein J, Wetterneck TB, Kaboli P, Mueller S, Burdick E, Nolido NV, Labonville S, Minahan JA, Orav EJ, Goldstein J, Schnipper JL. An On-Treatment Analysis of the MARQUIS Study: Interventions to Improve Inpatient Medication Reconciliation. J Hosp Med 2019; 14:614-617. [PMID: 31433768 PMCID: PMC6817307 DOI: 10.12788/jhm.3308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 11/20/2022]
Abstract
It is unclear which medication reconciliation interventions are most effective at reducing inpatient medication discrepancies. Five United States hospitals' interdisciplinary quality improvement (QI) teams were virtually mentored by QI-trained physicians. Sites implemented one to seven evidence-based interventions in 791 patients during the 25-month implementation period. Three interventions were associated with significant decreases in potentially harmful discrepancy rates: (1) defining clinical roles and responsibilities, (2) training, and (3) hiring staff to perform discharge medication reconciliation. Two interventions were associated with significant increases in potentially harmful discrepancy rates: training staff to take medication histories and implementing a new electronic health record (EHR). Hospitals should focus first on hiring and training pharmacy staff to assist with medication reconciliation at discharge and delineating roles and responsibilities of clinical staff. We caution hospitals implementing a large vendor EHR, as medication discrepancies may increase. Finally, the effect of medication history training on discrepancies needs further study.
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Affiliation(s)
- Amanda S Mixon
- GRECC, VA Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Nashville, Tennessee
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason Stein
- Section of Hospital Medicine, Emory University School of Medicine, Atlanta,
Georgia, and 1Unit, Atlanta,
Georgia
| | - Tosha B Wetterneck
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter Kaboli
- Center for Access Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, Iowa, and Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Stephanie Mueller
- Hospital Medicine Unit, Brigham Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elisabeth Burdick
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nyryan V Nolido
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Jacquelyn A Minahan
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- University of Kansas, Lawrence, Kansas
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jeffrey L Schnipper
- Hospital Medicine Unit, Brigham Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Schnipper JL, Mixon A, Stein J, Wetterneck TB, Kaboli PJ, Mueller S, Labonville S, Minahan JA, Burdick E, Orav EJ, Goldstein J, Nolido NV, Kripalani S. Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study. BMJ Qual Saf 2018; 27:954-964. [PMID: 30126891 DOI: 10.1136/bmjqs-2018-008233] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unintentional discrepancies across care settings are a common form of medication error and can contribute to patient harm. Medication reconciliation can reduce discrepancies; however, effective implementation in real-world settings is challenging. METHODS We conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The intervention consisted of local implementation of medication reconciliation best practices, utilising an evidence-based toolkit with 11 intervention components. Trained QI mentors conducted monthly site phone calls and two site visits during the intervention, which lasted from December 2011 through June 2014. The primary outcome was number of potentially harmful unintentional medication discrepancies per patient; secondary outcome was total discrepancies regardless of potential for harm. Time series analysis used multivariable Poisson regression. RESULTS Across five sites, 1648 patients were sampled: 613 during baseline and 1035 during the implementation period. Overall, potentially harmful discrepancies did not decrease over time beyond baseline temporal trends, adjusted incidence rate ratio (IRR) 0.97 per month (95% CI 0.86 to 1.08), p=0.53. The intervention was associated with a reduction in total medication discrepancies, IRR 0.92 per month (95% CI 0.87 to 0.97), p=0.002. Of the four sites that implemented interventions, three had reductions in potentially harmful discrepancies. The fourth site, which implemented interventions and installed a new electronic health record (EHR), saw an increase in discrepancies, as did the fifth site, which did not implement any interventions but also installed a new EHR. CONCLUSIONS Mentored implementation of a multifaceted medication reconciliation QI initiative was associated with a reduction in total, but not potentially harmful, medication discrepancies. The effect of EHR implementation on medication discrepancies warrants further study. TRIAL REGISTRATION NUMBER NCT01337063.
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Affiliation(s)
- Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda Mixon
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Jason Stein
- Internal Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Tosha B Wetterneck
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peter J Kaboli
- Internal Medicine, Iowa City VAMC and University of Iowa, Iowa City, Iowa, USA
| | - Stephanie Mueller
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie Labonville
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jacquelyn A Minahan
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabeth Burdick
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Endel John Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Jenna Goldstein
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Nyryan V Nolido
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kripalani
- Department of Medicine and Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, Tennessee, USA
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Baker TA, Clay OJ, Johnson-Lawrence V, Minahan JA, Mingo CA, Thorpe RJ, Ovalle F, Crowe M. Association of multiple chronic conditions and pain among older black and white adults with diabetes mellitus. BMC Geriatr 2017; 17:255. [PMID: 29084525 PMCID: PMC5663150 DOI: 10.1186/s12877-017-0652-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/22/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aging is often associated with the challenge of navigating daily tasks with a painful chronic medical illness. Yet, there is concern of the number of older adults impacted with more than one chronic condition. Despite the increasing number of adults diagnosed with diabetes and comorbid chronic illnesses, there remains a lack of understanding in how multiple illnesses relate to experiences of pain. To assess the association between multiple chronic conditions and pain, this study aimed to identify clusters of chronic medical conditions and their association with pain among a sample of older Black and White adults diagnosed with diabetes. METHODS Two hundred and thirty-six participants responded to a series of questions assessing pain frequency and severity, as well as health and social characteristics. A factor analysis was used to categorize clusters of medical conditions, and multiple regression models were used to examine predictors of pain. RESULTS Seven of the assessed chronic medical conditions loaded on three factors, and accounted for 57.2% of the total variance, with heart disease (factor 1) accounting for 21.9%, musculoskeletal conditions (factor 2) for another 18.4%, and factor 3 (microvascular diseases) accounting for a final 16.9% of the variability among the chronic medical conditions. Covariate-adjusted models showed that fewer years of education and higher scores on the microvascular and musculoskeletal conditions factors were associated with higher pain frequency, with the musculoskeletal conditions factor being the strongest predictor. CONCLUSIONS Findings from this study compliment existent literature underscoring the prevalence and importance of comorbid diagnoses in relation to pain. Examining health-related factors beyond a single disease diagnosis also provides an opportunity to explore underlying disease co-occurrences that may persist beyond organ system classifications.
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Affiliation(s)
- Tamara A. Baker
- Department of Psychology, University of Kansas, Lawrence, KS USA
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Vicki Johnson-Lawrence
- Department of Public Health and Health Sciences, University of Michigan-Flint, Flint, MI USA
| | | | - Chivon A. Mingo
- Gerontology Institute, Georgia State University, Atlanta, GA USA
| | - Roland J. Thorpe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Fernando Ovalle
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
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Minahan JA, Polychronakos AP. Density-correlation functions in Calogero-Sutherland models. Phys Rev B Condens Matter 1994; 50:4236-4239. [PMID: 9976718 DOI: 10.1103/physrevb.50.4236] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Minahan JA. Summing over inequivalent maps in the string theory interpretation of two-dimensional QCD. Phys Rev D Part Fields 1993; 47:3430-3436. [PMID: 10015961 DOI: 10.1103/physrevd.47.3430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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